Provider Demographics
NPI:1205004116
Name:STOVER, DAIVD W (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAIVD
Middle Name:W
Last Name:STOVER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9450 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 17
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3665
Mailing Address - Country:US
Mailing Address - Phone:301-599-1810
Mailing Address - Fax:301-599-1592
Practice Address - Street 1:9450 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 17
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3665
Practice Address - Country:US
Practice Address - Phone:301-599-1810
Practice Address - Fax:301-599-1592
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD72501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice